Using Intraoperative Recordings to Evaluate Surgical Technique and Performance in Mastoidectomy

Lee, Joshua A.; Close, Michaela F; Liu, Yuan F.; Rowley, M. Andrew; Isaac, Mitchell J.; Costello, Mark S.; Nguyen, Shaun A.; Meyer, Ted A.

doi:10.1001/jamaoto.2020.2063

Cited by 5 publications

(6 citation statements)

References 20 publications

(39 reference statements)

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“…The study demonstrated reasonable metrics for evaluation of surgeon skill level including drill stroke count, drilling efficiency, stroke pattern and use of suction irrigator. As evaluation and assessment can be time consuming, this study also highlighted how short video segments can provide valuable information on skill level [20]. Another study also focused on intraoperative recording of mastoidectomies for assessment, found that using objective metrics were more accurate than subjective assessment in differentiating surgeon experience level.…”

Section: Intraoperative Video Recording In Otolaryngology Education: ...mentioning

confidence: 86%

Intraoperative video recording in otolaryngology for surgical education: Evolution and considerations

Brennan

Kirby

2023

Journal of Otolaryngology - Head & Neck Surgery

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Background Otolaryngology is a surgical speciality well suited for the application of intraoperative video recording as an educational tool considering the number procedures within the speciality that utilize digital technology. Intraoperative recording has been utilized in endoscopic surgeries and in evaluating technique in mastoidectomy, myringotomy and grommet insertion. The impact of intra-operative video recording in otolaryngology education is vast in creating access to surgical videos for preparation outside the operating room to individualized coaching and assessment. The purpose of this project is to highlight the role of intraoperative video recording in otolaryngology training and elucidate the challenges and considerations associated with implementation. Methods Related publications between 1999 to 2022 were reviewed from PubMed and Embase databases utilizing search terms “intraoperative videography,” “video recording surgery,” “otolaryngology,” and “surgical education.” 109 articles were screened independently by HB and SK, by title and abstract then full text review. 28 articles from the original search and 6 from the secondary reference review were included. Results The application of intraoperative video recording is evident in otolaryngology surgeries including endoscopic sinus surgery, laryngeal surgery, and other endoscopic procedures. There have been significant advancements in recording tools, including devices that can capture the surgeon’s perspective. The considerations and challenges identified with utilizing this educational tool were categorized into different themes including ethics/consent, regulation, liability, data, technology, and human resources. Conclusion Intra-operative video recording has been demonstrated to have significant impact within otolaryngology education. It is critical to elucidate the challenges and considerations involved to utilize this educational tool effectively. Future directives will see video-based performance analytics providing comparative metrics to encourage precise coaching of surgical residents.

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Section: Intraoperative Video Recording In Otolaryngology Education: ...mentioning

confidence: 86%

Intraoperative video recording in otolaryngology for surgical education: Evolution and considerations

Brennan

Kirby

2023

Journal of Otolaryngology - Head & Neck Surgery

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“…It is not surprising that mean drill speed increases with resident experience level, as similar findings have been reported in the studies of simulated and cadaveric mastoidectomies (14,17). These increases could be attributed to the increased confidence or efficiency a surgical resident obtains as they become more experienced in performing a mastoidectomy (18). When analyzing residents individually, all seven residents displayed increases in drill motion as they progressed through training.…”

Section: Discussionmentioning

confidence: 99%

“…Although one previous study demonstrated that some drill metrics subjectively assessed from video recordings by raters could be used to differentiate novice from experienced surgeons, the utility of SI metrics in differentiating surgeon experience level is less clear (18,20). In the current study, we observed that SI speed increased from the PGY2 to PGY4 level, then decreased to the PGY5 level.…”

Section: Discussionmentioning

confidence: 99%

Video Analysis of Otologic Instrument Movement During Resident Mastoidectomies

et al. 2022

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ObjectiveTo measure surgical instrument movement during resident mastoidectomies and identify metrics that correlate with experience.Study DesignRetrospective case series.SettingTertiary care center.SubjectsTen postgraduate year (PGY) 2, 6 PGY3, 7 PGY4, and 19 PGY5 recordings of mastoidectomy performed by otolaryngology residents.InterventionsOne-minute intraoperative recordings of mastoidectomies performed during cochlear implantation were collected. Drill and suction-irrigator motion were analyzed with sports motion tracking software.Main Outcome MeasuresMean instrument speed, angle, and angular velocity were calculated. Mann-Whitney U tests compared mean instrument metrics between PGY levels. Change in drill speed for seven residents between their PGY2 to PGY5 years was individually analyzed.ResultsMean drill speed was significantly greater for PGY5 residents compared with PGY2s (2.9 versus 1.8 cm/s, p = 0.001). Compared with PGY2 residents, suction speed was greater as a PGY5 (1.2 versus 0.9 cm/s; p = 0.201) and significantly greater as a PGY4 (1.5 versus 0.9 cm/s, p = 0.039). Of the seven residents individually analyzed, group mean drill speed increased by 0.4 cm/s, yearly.ConclusionsDrill and suction-irrigator movement during the second minute of drilling of a cortical mastoidectomy seems to increase with resident level. Objective video analysis is a potential adjunct for differentiating novices from more experienced surgeons and monitoring surgical skills progress.

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“… 2 Video-based evaluation has been used across different surgical fields to evaluate proficiency and has been useful in examining variability in technique, outcomes, and areas of improvement for surgeons and trainees. 3 , 4 , 5 , 6 For example, video review for bariatric surgeons demonstrated that better surgical skills were associated with lower 30-day postoperative complications, reoperation, readmission, and visits to emergency departments. 7 Similar studies with laparoscopic sleeve gastrectomy and pancreaticoduodenectomy have demonstrated an association between skill and outcomes.…”

Section: Introductionmentioning

confidence: 99%

Surgeon Skill and Perioperative Outcomes in Robot-Assisted Partial Nephrectomy

Wang,

Wilder,

Hijazi

et al. 2024

JAMA Netw Open

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ImportanceTechnical skill in complex surgical procedures may affect clinical outcomes, and there is growing interest in understanding the clinical implications of surgeon proficiency levels.ObjectivesTo determine whether surgeon scores representing technical skills of robot-assisted kidney surgery are associated with patient outcomes.Design, Setting, and ParticipantsThis quality improvement study included 10 urological surgeons participating in a surgical collaborative in Michigan from July 2021 to September 2022. Each surgeon submitted up to 7 videos of themselves performing robot-assisted partial nephrectomy. Videos were segmented into 6 key steps, yielding 127 video clips for analysis. Each video clip was deidentified and distributed to at least 3 of the 24 blinded peer surgeons from the collaborative who also perform robot-assisted partial nephrectomy. Reviewers rated technical skill and provided written feedback. Statistical analysis was performed from May 2023 to January 2024.Main Outcomes and MeasuresReviewers scored each video clip using a validated instrument to assess technical skill for partial nephrectomy on a scale of 1 to 5 (higher scores indicating greater skill). For all submitting surgeons, outcomes from a clinical registry were assessed for length of stay (LOS) greater than 3 days, estimated blood loss (EBL) greater than 500 mL, warm ischemia time (WIT) greater than 30 minutes, positive surgical margin (PSM), 30-day emergency department (ED) visits, and 30-day readmission.ResultsAmong the 27 unique surgeons who participated in this study as reviewers and/or individuals performing the procedures, 3 (11%) were female, and the median age was 47 (IQR, 39-52) years. Risk-adjusted outcomes were associated with scores representing surgeon skills. The overall performance score ranged from 3.5 to 4.7 points with a mean (SD) of 4.1 (0.4) points. Greater skill was correlated with significantly lower rates of LOS greater than 3 days (−6.8% [95% CI, −8.3% to −5.2%]), EBL greater than 500 mL (−2.6% [95% CI, −3.0% to −2.1%]), PSM (−8.2% [95% CI, −9.2% to −7.2%]), ED visits (−3.9% [95% CI, −5.0% to −2.8%]), and readmissions (−5.7% [95% CI, −6.9% to −4.6%]) (P &lt; .001 for all). Higher overall score was also associated with higher partial nephrectomy volume (β coefficient, 11.4 [95% CI, 10.0-12.7]; P &lt; .001).Conclusions and RelevanceIn this quality improvement study on video-based evaluation of robot-assisted partial nephrectomy, higher technical skill was associated with lower rates of adverse clinical outcomes. These findings suggest that video-based evaluation plays a role in assessing surgical skill and can be used in quality improvement initiatives to improve patient care.

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Using Intraoperative Recordings to Evaluate Surgical Technique and Performance in Mastoidectomy

Cited by 5 publications

References 20 publications

Intraoperative video recording in otolaryngology for surgical education: Evolution and considerations

Intraoperative video recording in otolaryngology for surgical education: Evolution and considerations

Video Analysis of Otologic Instrument Movement During Resident Mastoidectomies

Surgeon Skill and Perioperative Outcomes in Robot-Assisted Partial Nephrectomy

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